Provider Demographics
NPI:1528186277
Name:CRAWFORD, BRUCE DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DENNIS
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2259
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-2259
Mailing Address - Country:US
Mailing Address - Phone:828-898-3373
Mailing Address - Fax:
Practice Address - Street 1:600 AMITY PARK RD
Practice Address - Street 2:DENTAL-AVERY MITCHELL CORRECTIONAL INSTITUTION
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777
Practice Address - Country:US
Practice Address - Phone:828-765-0229
Practice Address - Fax:828-766-7015
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist